Detecting Alzheimer’s early called key to puzzle

AT UM CENTER ON AGING: Neuropsychologist Dr. Rosie Curiel, left, is involved in a study of healthy adults ages 63 and older, like Paul Herman, right, to determine if those at risk of Alzheimer’s could be detected before symptoms begin.
Al Diaz
Miami Herald Staff

AT UM CENTER ON AGING: Neuropsychologist Dr. Rosie Curiel, left, is involved in a study of healthy adults ages 63 and older, like Paul Herman, right, to determine if those at risk of Alzheimer’s could be detected before symptoms begin.
Al Diaz
Miami Herald Staff

Paul Herman, 63, of North Miami knows firsthand the pain that Alzheimer’s disease can bring. When his mother died in October 2014, she was in the early stages of the disease.

Now Herman, a real estate investor in good health, is honoring his mother’s memory by participating in a clinical trial at the University of Miami Miller School of Medicine to help in early detection.

“By the early 2020s, approximately 25 percent of the population of this country will be baby boomers, and there’s going to be a large aging population,” Herman said. “I’ve seen firsthand what it can do to a person, and how it affects the families. It’s just bad all the way around, and it needs to be dealt with.”

Alzheimer’s, the most common form of dementia, is characterized by progressive memory loss and decline in mental function. One in nine Americans ages 65 and older suffer from the disease, which affects about 5.2 million in the United States, according to the Alzheimer’s Association.

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Risk factors

The biggest risk factor is age, said Dr. Po-Heng Tsai, a neurologist with Cleveland Clinic in Weston. Between ages 60-65, about 5 percent are at risk. “But that risk doubles every five to 10 years, so by the time that person is in their 80s, it’s an almost one-in-two chance,” he said.

Having a first-degree relative, a parent or sibling with dementia or Alzheimer’s raises a person’s risk about 10 to 30 percent, Tsai said.

Some studies suggest that a lack of physical activity increases risk, but there is more evidence that vascular risk factors such as high blood pressure, diabetes and high cholesterol are also risk factors for Alzheimer’s, he said.

Prevention

In terms of prevention, studies support a Mediterranean diet, one rich in fruits and vegetables, to supply your body with antioxidants, plus fatty fish, nut and olive oils to give you Omega-3 acids, Tsai said.

Eating a healthy diet is better than taking supplements, he said. “One reason is because we don’t know if there is anything else in the food beside the isolated compound that could be beneficial to the brain,” he said. “The other concern is that recently it has been discovered that some supplements do not contain what they claim to contain. They are not regulated by the FDA.”

Exercise is recommended, but there is no one regimen better than the other, Tsai said. The key is consistency. “I tell my patients to be physically active for 20 to 30 minutes a day,” he said. “When we exercise, the oxygen in the blood gets to the brain, and we know, at least in animals, that this will encourage the production of new brain cells.”

That doesn’t mean you have to go to the gym every day, Tsai said. Incorporate physical activity into your daily lifestyle: park a little farther away when you go shopping. Take a couple of flights of stairs instead of using the elevator. Take walks every day and intermittently walk briskly.

For brain training, mental exercises such as puzzles, games, or websites with cognitive training exercises can help encourage the formation of new connections in the brain, Tsai said.

Symptoms

Sometimes you forget to pay a bill or make a wrong turn. “Everyone can have occasional forgetfulness, especially if you didn’t sleep well the night before, or didn’t have your morning cup of coffee, that happens to all of us, and you carry on with your life,” Tsai said.

But if you are consistently forgetting to take your medicine or pay bills every month, or are frequently getting lost, then that is more concerning, Tsai said. When looking for signs of the disease, look at day-to-day activities. Are the symptoms you are having affecting your daily function?

Dr. Rosie Curiel, a neuropsychologist and assistant professor of psychiatry and neuropsychology at the University of Miami Miller School of Medicine, said besides being forgetful, a patient might have trouble multitasking. They might lose track of conversations and begin repeating things.

Diagnosis

Typically a patient will see a neurologist or psychologist for help, Curiel said. Generally, a patient will under undergo a neurological exam, and sometimes an MRI of the brain, to look for tumors or causes for the gaps in memory. In many cases, “It will be grossly determined, if the person is symptomatic, that the person has Alzheimer’s dementia,” Curiel said. “It is very general, and not sensitive to other factors that may contribute to memory loss, such as depression.”

At the University of Miami, family history, genetic testing and the progressive course of challenges are also documented when making a diagnosis. An MRI of the brain and cerebral spinal fluid are examined for proteins called amyloid and tau that cause degenerative changes in the brain, Curiel said.

A form of amyloid called beta-amyloid clumps together into “plaques” that are toxic to nerve cells in the brain, said Dr. Ranjan Duara, medical director, Mount Sinai Wien Center for Alzheimer’s Disease and Memory Disorders. These plaques are one of the indicators of Alzheimer’s when brain tissue of a patient is examined after death, he said.

On average, it takes about 15 years after beta-amyloid is deposited in the brain before Alzheimer’s symptoms appear, Duara said. Before then, a PET Scan can determine how much amyloid is in the brain and where it is located. A spinal tap also can determine if amyloid is being deposited in the brain, but not where it’s located, he said.

Research

At Mount Sinai, Duara said there are several research studies underway regarding the amyloid protein.

One study is aimed at prevention through early intervention.

Duara said to date, there have been six or seven clinical trials on patients with mild to moderate Alzheimer’s using antibodies that remove amyloid from the brain. “All of them have failed to change the course of the disease, except one,” he said. In that study, the antibody slowed the progression of the disease in patients with mild symptoms, as opposed to moderate symptoms.

“That raised the concept that the earlier you go, the more likely you are to be able to intervene effectively,” Duara said. “The concept was if you intervene too late, there is too much damage to the brain … the amyloid protein no longer has an impact on the disease process. However, if you intervene early, perhaps when individuals are completely normal, as soon as you can detect the amyloid protein, you might be able to effectively intervene.”

The Mount Sinai study is testing patients who have elevated levels of amyloid in the brain, but who have no symptoms. The randomized clinical trial uses an infusion of the antibody or a placebo. The three-and-a-half-year study began in mid-2014 and is examining whether the antibody prevents decline in brain function not attributable to normal aging.

Another study of people with mild cognitive impairment is looking at attacking the enzymes that break down the larger amyloid protein into beta-amyloid, the toxic form of the protein. A study began about a year ago and will conclude in 2016 or later.

A third study, which will begin in a month or two, will look at improving the resistance of the brain to toxins such as amyloid and others that cause degenerative brain disease. “This is a study aimed at protecting the nerve cells from damage,” he said.

At the University of Miami Center on Aging, Curiel is involved in a study of healthy adults ages 63 and older like Paul Herman to determine if those at risk for Alzheimer’s could be detected before the onset of symptoms. The five-year study, which began Feb. 1, looks at cognitive and biological markers and how they relate to mild cognitive impairment. Participants undergo tests to assess cognitive and functional abilities, as well as genetic testing and testing of amyloid levels in cerebral spinal fluid over a five-year period.

“We’re trying to detect the earliest changes that occur in the aging population that make them at risk for developing a memory disorder,” Curiel said.

Researchers are trying to refine the formula of early detection, she said. “We’re looking for links and patterns that can help us better define what is healthy aging, versus what is risk for cognitive decline,” Curiel said.

In the best-case scenario, the science will be used to develop drugs for people who are pre-symptomatic but who have a lot of risk factors. “Drugs that can put the speed bumps down and slow the progression into dementia so that people can live healthy and independent lives for as long as possible,” she said.